|Antiplatelet and Anticoagulant Agents and Dental Procedures|
An increasing number of dental patients are taking “blood thinner” medications for various medical conditions. These drugs interfere with the body’s normal clotting (stopping blood flow) mechanism.
There are two main processes by which the body normally forms a blood clot at the site of tissue injury. The first involves small blood cells called platelets which clump together at the wound to form a mechanical plug. This plug slows the flow of blood through the vessel and forms a matrix for the next phase of coagulation. During coagulation chemicals in the blood interact with each other to fill in the spaces between the platelets, stabilize the clot, and make it more solid until the process stops the bleeding.
Antiplatelet agents such as aspirin, Ticlid (ticlopidine), and Plavix (clopidogrel) target the first phase of clot formation by preventing platelets from sticking together and adhering to blood vessels. These agents do this by creating permanent changes in the platelets which last throughout the lifetime of the platelet (7-10 days). These effects can only be countered as the body produces new platelets that have not been exposed to the drug.
Anticoagulant agents such as warfarin (coumadin) inhibit the second phase of clotting by blocking production of proteins that stabilize the clot. Warfarin can only affect these blood proteins when they are being made. This means that it takes several days for the drug to reach full effect and that anticoagulation also goes away slowly when the medication is stopped. Consequently, when changing the levels of anticoagulation, this process must occur gradually. Another important fact is that the effect of warfarin is influenced by many foods and other drugs, resulting in the need for frequent monitoring by the physician.
Many procedures in dentistry can produce bleeding (see Box to Right). Most of the time this bleeding is not difficult to control even in patients who are taking anticoagulation and antiplatelet medications. However, both the effect of these medicines on clotting and the potential for bleeding associated with particular dental procedures is variable. Consequently, it is essential that for each procedure that the risk of bleeding be weighed against the risk of altering the dose or discontinuing the medication.
Some Dental Procedures Associated with Bleeding:
Your dentist will want you to provide a thorough and complete medical history. Factors that he/she may ask you to provide include: all current medications; name of your physician; purpose of antiplatelet and / or anticoagulation therapy; anticipated time that you will be on these medications; the results of any laboratory monitoring of the effects of these agents; and any problems that you have had with your medicines. Your dentist may want to consult with your physician and it may be necessary to run some tests before your treatment (see Box to Right). Furthermore, precautions may be made before, during and after the dental procedure to reduce the risk of significant oral bleeding. Do not discontinue or alter your medications without the advice of your physician and dentist.
QUESTIONS AND ANSWERS ABOUT ANTIPLATELET AND ANTICOAGULANT MEDICATIONS
Q: Is it necessary to check my clotting times before a dental appointment?
Q: Why not stop my blood thinners before dental care just to be safe?
Q: What measures can I take to minimize bleeding after a dental procedure?
Q: At what point do I seek help for oral bleeding and whom should I contact?
Q: What other precautions should I take if I am on antiplatelet or anticoagulant medications?
Additional Information May be Obtained from the American Heart Association
Prepared by J. Napeñas and the AAOM Web Writing Group
The information contained in this monograph is for educational purposes only. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.